UPDATE: the effective date has been changed to April 1, 2025, for Individual Under 65, Small Group Fully Insured, Large Group Fully Insured, and Truli for Health Members. They will be receiving a letter alerting them of the change in effective date.

Beginning on January 1, 2025, some brand diabetic drugs will no longer be a part of Florida Blue's Condition Care Rx Program (CCRX) and will cost the standard brand share. This is part of an initiative to reduce brand cost on the condition care list and focus on cost-effective generic drugs for preventive care.

These drugs are currently (as of 2024) covered at waived or reduced deductibles and cost shares for individual members under age 65 on the CareChoices formularies, and for members on group plans with the Health Savings Account (HSA) Preventive or Value-Based Drug Preventive drug list. This also applies to Truli for Health members who are a part of the Truli for Me program. 

This announcement does not apply to insulin or to diabetic testing supplies.

The following drugs will begin requiring the standard cost share as of January 1, 2025:

Letters to affected members were sent on November 1, 2024. In addition, Florida Blue is communicating this change through provider bulletins, customer service bulletins, and an email to affected groups.

Members should be prepared for higher out-of-pocket costs for these medications beginning January 1, 2025. They can talk to their doctor about covered medications for their condition that are lower cost. The list of drugs is available in the medication guide. Note: if a doctor recommends a different drug treatment, the member will need a new prescription that can be filled at an in-network pharmacy.

Contact your Amwins Connect Regional Sales Manager for talking points and further information.